National Review Institute Ideas Summit Speaker Paul Ryan CSPAN March 17, 2017 9:18pm-9:54pm EDT
spoke about the republican plan to replace the affordable care act at a conference hosted by the national review. we will show you the speaker's remarks first. this is about one hour. >> good morning, everyone. welcome to our session with speaker ryan. the speaker of the night. [applause] >> the speaker is only able to join us this morning because he hain else going on. say you'rewant to going to get hit from the left and right, occasionally he is getting hit from the national review. we appreciate you, we appreciate what you're doing and thank you for being here. mr. ryan: thank you.
>> let's dive in on this very important question of nomenclature. trumpcare?are or wherever you are, that is the bigger stage. let me say one thing about it. inracked my first issue 1989. i had a conservative austrian economist professor that said, i think you and i look -- think alike, you should look at this magazine and it was the national review. i have been reading this thing ever since. and not every time do conservatives agree on everything on -- but on 95% of
the stuff we do and i want to say how much i appreciate national review because it helped form may, who i am and how i think today. >> we appreciate that. we have a little personal history that paul may have forgotten. when i was selected as editor kind of miraculously in my 20's, my housemates when i was living here gave me a kick party to send me off to washington and paul attended when he was a made a prettily early exit from this party. i remember when he was leaving and we -- she was going up to run for congress and i said i cannot believe we are becoming those people. he wasdid i know what talking about was becoming speaker of the house. you have said that this bill is going to be -- needs changes to get through. what sort of changes? mr. ryan: this is the legislative process which is you have in our house is a -- it is
process.mmittee the budget cannot amend the bill. resolutions asking for the rules committee to make resolutionsthe two they called for in the budget even moreterday was federalism, even more things that gives states an governors the ability to customize without for their needs having to go to hhs for work requirements and things like that. what we are working on is even more federalism for the medicaid population to give governors the ability to be completely free to customize medicaid to their needs. other issues we are looking at on -- are how well the tax credit would work and those kinds of things, the point being what we are doing is listening to all peoe conin ourrence in making sure that we can make the changes that improve the bill that -- and refine the bill, the big pieces are all there. the president, i think he just
got off the news, he was meeting with the republican study committee that you and i cut our teeth on. he worked with them and they are they with these president and the rest of us have been talking about improvements. those improvements are being made as we go through this process. it is basically more federalism, making sure that we respect the fact that states can experiment taylor medicaid to meet their needs and as we get through this what we're finding out is, this is an exciting time. i know what is happening is people are saying i wish you had this or that reform in this bill , the challenge for us in the bill is we have to work with the senate rules, and the senate rules are pretty tight on this thing called reconciliation, which means you have to write a bill that cannot be filibustered. you cannot put everything you want in a bill otherwise it will be filibustered and it will be a showboat, it will be a phony
fake vote. about a lot of votes obamacare that we knew could get filibustered. we did not want to go down that path, we have a once-in-a-lifetime chance of repealing and replacing obamacare so we have to use those senate rules to do that so i cannot get filibustered. we proved in the last session that we can put a bill on the president's desk repealing obamacare, fiscally cutting the law. we have taken that bill and added replace. so many of our members, conservatives and anybody in between including the president have said to repeal and replace, do not just repeal it and have e thing collapse. repeal it and replace it with patient centered health care that is market driven, that gives people the ability to go and do and to buy what they want nad regular did market place. deregulated >> you are
the house, why don't you replace the bill that does not take account in what is going on with the senate and pass the bill and let mitch mcconnell mess it up later rather than starting out with what people feel is a compromise. we do that, they cannot bring the bill up in the senate. chuck schumer can say this itlates the byrd rule and takes 60 votes to consider it. mitch mcconnell cannot bring it up. we said that does not conform to reconciliation of the rule, the senate cannot consider the bill. they can filibuster even going on the bill. that is why we have to write this in such a way that chuck schumer cannot block it from coming to the filibuster so mitch mcconnell can make sure they can vote on the bill and get that bill passed. there is a three-part plan here. we can usebill that
reconciliation for that they cannot filibuster. that is where you can repeal the individual and business mandate, that is where you can repeal the spending and the taxes, you can put in the republican health care tax policy, high risk pools, health savings accounts, tax credits that equalize the tax treatment of health care, the moving parts we can do in reconciliation. part two and tom price came to a conference two hours ago and walked our members through the enormous regulatory flexibility that he has. when they brought obamacare they wrote this in harry reid's office in christmas -- on christmas eve of 2009. they were going on the fly and they said there's a lot of stuff we cannot figure out, let's have the secretary figure it out. they put 1442 provisions in obamacare and the 2700 page bill, there are 1442 sections that say the neck or secretary shall, it lives hundreds of
discretion to the secretary of hhs to figure it out. they did not think that president -- trump would be president. thisrice walked us through morning, these are all the things we can do using that flexibility in reverse to open seehe marketplace, to -- i one of the brilliant state senators we have in wisconsin. rice'sin because of tom -- price's regulatory authority, they can say you guys and set up your own health care marketplace, your own regulatory structure so that wisconsin can have whatever kind of plans wisconsin wants to have an the a'sublican tax credit, the hs and risk pools, you can use that for those. deregulate and have the patient centered states rights run system. part three are thether bills
we would like to pass that we think make the situation even better, but are not necessary to fix a problem, make it even better. that is what interstate shopping, medical liability reform are about. what the president is eager to do is to crisscross this country making the case for those policies and i think it might be interesting to note that he will crisscross in those 10 states wheree carried widely there is a democrat up for reelection in 2018. isso what you're saying because the senate rules -- of the senate rules, we cannot fully deregulate obamacare in price'sislation but tom administrations -- administrative actions are a big step. mr. ryan: if it is fiscal policy, you can do it. if it is regulatory policy, you cannot. that is the easiest way to describe it. putting as much replace policy
as we can that can conform to the senate rules so they cannot block the ill from even being considered, has that and the administration in part to which they are working on right now simultaneously, can do that kind of deregulation that let the states go back and set up their own marketplaces, that is part two. part three, pass these other bills and they are ringing them to the floor next week, pass these other bills we believe in that you cannot put in reconciliation. >> let's go to some policy critiques. what you will hear from health-care wonks, usually wonks are 100% on board with what all doet and comes -- paul ryan willu are -- that itself make the individual market even more unstable than it is now.
there is a provision for a surcharge on your insurance if you have not been covered and you are jumping back into coverage but they feel that is much of an have effect so the bill will make the individual market worse than obamacare. mr. ryan: we do not agree but we can self actuate insurance companies on a daily basis and they are telling us the opposite. guaranteed issues are baked into the cake and insurance market is priced in. we do change committee rating. obamacare compressed community rating. that they would have young, healthy people subsidize older, less healthy people in that they would work if we force them to buy this stuff. that is not working. the individual mandate is not working, people are taking the penalty and exchange and therefore this is death spiraling, it is failing, insurers are pulling out. we are relaxing that community
rating standard so it goes back to reflect the actual cost of insurance and that is why the tax credit is age-adjusted, so that it reflects those actual costs of insurance and it is why we have state-based high risk pools. there wasn't a federal funding component with it. the federal government will help kickstart insurance pools. what that means is, in the you havel market, extra coverage for a person with a catastrophic illness. cost, itancer, your kicks in and helps you get affordable coverage so you don't go broke if you get sick. it also cap's the exposure for insurance for everybody else. in fact, a medically lower steep price for everybody else. to give you an idea, 1% of the people in this individual market drive 23% of the cost of insurance. if you have risk pools, which
obamacare abolished, that covers that. you age of just the tax credit, to regulate marketplace, to bring the consumer back in the game to have people with skin in the game price pressure a marketplace for competition on choice, quality, and price. viable how you restart a free market health care. it is not just a theory. where these ideas have been tried, they have worked. what the insurers are telling us will come back into the marketplace. we will bring mark -- prices down. even the cbo is telling us in their score, when these reforms begin, premium start going down. mr. lowry: are these things insurers are telling you privately? rep. ryan: the insurance companies can't make a projection, because they are publicly traded. they can't say these things specifically. they inform us of these things.
cms, now run by s, republicans show us these things. we get a letter from anthem, one of the biggest insurers and america, one of the biggest players in the exchange market, and they put that in writing. mr. lowry: let's talk about credit. another criticism you will hear is there is an effect of a medicaid claims in this bill where medicaid benefits you get and the credit will be worth much less. hurt be very to working poor, working-class, that are a big element. i would say that by having more market flux ability, by letting states open up and having different parts to offer, people will get a coverage plan with a tax credit. but we have always believed as -- what we have
always believed as conservatives -- we discriminated against evil in the tax code who don't get health care from their job. by getting a tax credit by deregulating the marketplace, you will have a more viable marketplace for that person to go into that is better than the status quo. mr. lowry: i don't have a problem with the credit. i agree with you on that. the credit is not generous enough. would you be open to making it more generous? rep. ryan: those are things we are talking about. that is possible. they are being considered and looked at. mr. lowry: let me ask you something that confuses me. you have a lot of defenders of saying theut there problem with obamacare is it gives you coverage, but you can't get care because it's not
good coverage. what they are criticizing is the catastrophic health care plan. you have high deductibles, so you have to play for best pay for routine expenses, but it is there for you. law, buta health care i felt that with the republican plan. i thought we wanted to get everyone catastrophic coverage. rep. ryan: we believe in catastrophic coverage. we believe in having skin in the game. what do you have underneath that? health savingsed account. i co-authored that law. hsapurpose of each as a -- 's was to give people out-of-pocket costs. we want to give free market principles and to help there, which have been missing. look at the sectors in our economy that provide some of the most important aspects of our life we need, education and health care.
why do the costs go up faster than everything else? government. we want be basic principles of a market, transparency and price, transparency and quality, and then incentive to act on those things. health savings accounts gets you that. let me give you an example. better 33ree kids months apart. we have three -- have had three tonsillectomy three years in a row. the same doctor at the same pulse -- hospital. upfront front, we asked what is this going to cost? they couldn't tell me what he was going to cost. i would get the bill, bills three or four or five months afterwards. son, it was $4000 for the recovery. -- $00 for recovery. he watched tv on a lazy boy and
went home. how does that cost that much? mris are a perfect example. they can vary in price from $700 to $3000 in the milwaukee area based on the last numbers we looked at. this is not a marketplace. hsa's, getting consumers in the marketplace saying i want to know what this is going to cost me. we need help of the american consumer in person and patient to help us fix this health care problem by going into this marketplace and demanding that these providers of our care and services among doctors, nurses, insurers, compete against each other for our business based on quality and price and outcome, and there is nothing that does this more than health savings accounts. that is our mission, the way we
want to go. believe this idea of crating a strong, powerful individual market with all of these market-based incentives will help us get at the root cause of this problem, high health inflation. it's other people's money. if you think it's somebody else's spending money on your health care, you don't really care how much money you are spending. if your employer says, i am going to pay for your food also, you're going to go home and on your way home you will get fully mignon and lobster tell. if it's your money, you care. that is the critical market mechanism that we think we are getting restored here to help crack this big problem. mr. lowry: let's move to the politics. the question within your own caucus, if you are an outside observer, yoprobably think, the r haa problem on his right. , threee we see on tv people i am thinking of particularly, are members of the
house freedom caucus. in terms of persuasion you need to do among our members, you have more to do among the conservatives? rep. ryan: some people negotiate on tv and some people not on tv. those are the different procedures people use. this is the legislative process. it's very transparent. i would say 10, 20 years ago it was less transparent. i like the transparency. people are articulating their issues and concerns privately or publicly, but it comes from both sides. our job is to find that sweet spot. where we landing place can bring a bill that can pass. this means, if we are ever going the federal i and capping its growth. that is incredible. in orders of magnitude on how much this saves are huge.
another entitlement, we are repealing. obamacare is an open ended subsidy that we are repealing and we are replacing with long-standing conservative tax policy be all believe in. what i try to help people understand or see is look at the enormity of this accompaniment, but if we are going to accomplish it, we have a bill that can pass that can do this. that is the landing spot we are to get everybody to. there are people from the middle and right who have various concerns. we are trying to make sure we address as many as possible without destroying the bill, without violating the sue bird rule.- this byrd we feel very good. the president has been a great closer on this. he has been the one that has gotten engaged in the last couple weeks away -- who is helping with these negotiations. he has been extremely
constructive in making sure we get this right. mr. lowry: there is conventional wisdom among the journalists in the back of the room here, the president has been supportive, but he is also maintaining his flexibility, and if he -- you don't find that sweet spot and it looks like it's going down, he is g to bail and it's going to be ryance -- ryancare forevermore. rep. ryan: i didn't come here to be popular, i came here to get stuff done. [applause] you know me long enough. i just want to get this stuff done. i see a once-in-a-lifetime opportunity. by the way, he is fully committed. 20 minutes ago she had a senate committee that endorsed this. the caucus just cannot in support of this. the national rights announced the mostthis is one of pro-life pieces of legislation we could pass.
we think we are moving in the right direction. i would say that's not the case, but let's pull back for a second. this is a moment that may not come back around again. republicana president, senate, and house. it is a razor thin republican majority, but if we do not see this moment for what it is, shame on us. i look at it, and i say, let's do the scott walker plan. is theyse governors did went big, bold, they took their principles and put them in place, the past those reforms, and they worked. this is what we have to do here. this is our operating theory, and that is why mitch mcconnell and i spent november, december, and january working with the president and his transition team mapping out a 200 day agenda for how we achieve and
diplomat this agenda we have all discussed. we are exactly where we are planning and hoping to be in executing this. we go from health-care reform, tax form, one helps the other dramatically. because of revenues. $1are stripping about trillion of revenues out of the tax code bre, which makes tax reform when chilean dollars easier. that is not chump change. that is about 10% of rate cuts on businesses. mr. lowry: donald trump one in november by tearing up the rulebook. not just by clinical tactics, but by republican orthodoxy. is there anything about his victory that makes you reconsider or want to think more deeply about elements of your own worldview? rep. ryan: sure.
you always have to think about that. i think what the president did the most and gave the best voice to his what i would call the real forgotten man and woman in this country. onehave to remember, i come from wisconsin. -- come from wisconsin. ourometown got crushed when gm plant left in 2009. half the people i went to high school with, their parents worked there, and the idea was you could get a job there. i had buddies from school that works the plant and make six figures. and now have jobs that make them about one third as much. that,k he gave voice to and i think that's real and palpable. i think we have to make sure that our conservative principles actually translate into real tangible results that prove the lives of these men and women who have been forgotten and feel they have been forgotten.
refocuses ourhat minds to make sure our policies reflect those things. i think what you have your -- have here is a beautiful fusion. of conservative principles and this healthy populism. is dealing with the economic and fridays at the men and women in this country and making sure our principles applied rightly and offer policy that addresses these things. that is what i feel like we need to focus on achieving. mr. lowry: so the answero the question is just a greater focus on the economic interests? more of a focus and you would have had a year or two ago? rep. ryan: i think we need to prioritize better. we have to prioritize better.
let's focus on the basics and get that going right now. reform, inthis tax my worldview, means, let's get manufacturing going in. what about the person who is going to go to tech school and become a welder or a machinist? economyto have a an that provides them a good way of life and living. those are issues i think we need to address. welfare reform i think is where we are basically paying people or discontent -- this incentivizing people. i think that is were we need to have priorities focused on. mr. lowry: tax reform. you have had a lot of blowback from some of these conservative groups on the border adjustment tax. that say it's just going to be passed on to consumers and going to hurt certain sectors and can
be highly disruptive. rep. ryan: i beg to differ on that. i have been doing tax reform since the early 1990's. going to a consumption tax for businesses is the most economically neutral kind of tax you can have. the fair tax border adjusts. that is a very popular conservative tax reform plan. lots of these tax reform plans, people just didn't know it until now. is 160nt it would make countries border adjust today. we don't, along with afghanistan and north korea and somalia. the older countries. 160 countries border adjust their taxes. we don't do that, and as a result, the way our system works, we incentivize businesses to move their manufacturing overseas. we incentivize businesses to relocate overseas.
and the tax code today, it makes less sense to be here and make things here then overseas. why do we want to keep doing that? our biggest public and trade business in wisconsin was a business called johnson controls. until a year ago, the company was an american company that had a 35% tax rate worldwide. now, they bought and became an irish company and that is a toll percent tax rate now. we are losing businesses and our competitive edge. the whole purpose of a border adjustment tax is it gives back and being competitive. the good thing for us is our government is still smaller relative to our peers. it is 20% of gdp. we have a 20% of gdp government, but we have the worst tax code in the industrialized world. incomeer countries have tax businesses and a consumption tax. what they are doing is they are realizing the income tax is that for growth, so they are lowering
their income tax rates, making it up on their consumption tax. meanwhile, we have an ugly uncompetitive income tax that is pulling capital manufacturing from our country to others. basically saying, let's put our system and make a destination based tax, which is another way of saying a consumption tax. as conservatives, we don't want to have a back tax. we don't want to have a consumption tax that is sneaky with respect to the size of the government. we want the instance of taxation to continue to fall on the person, so they see, know, and feel the true size and cost of their government. we want to have a tax system that is extremely competitive internationally, so the plan we are offering we know is better than anybody else in the world. i would rather win tax competition. i would rather, like ronald reagan did, have a tax system that is better than anybody else in the world. if we have to stick with income tax system, we know from
research in the ways and means committee that we can do tax reform on it income tax, but it would give us a mediocre tax. we can go for the worst two behind in the middle. i would rather to -- go to the front of the pack and have the best tech system for american works -- workers and companies and put us in number one with respect to being competitive globally. mr. lowry: have you got the president to adverse it? rep. ryan: we are working on it. this whole conversation is getting to the sweet spot where we agree. he already started with his texting in the campaign that looks like what we put out there with some differences that we are still working on. we are getting closer and closer. same thing with health care. this kind of conversation, we are getting closer in getting consensus. i would say what is happening right now in the conservative movement is the necessary growing pains of going from
being a 10 year opposition party to a governing party. the last two years of bush, for the last 10 years, we were just opposing. we were getting good at opposing. as we got down that path, we have got these firing squads going as low. believe in what we believe in, then we need to harmonize, come together, and be a conservative governing party so we can make good on these ideas. what good is it to -- we have a chance of making a difference. we have got to come to consensus as conservatives and figure out how to deliver on these reforms. this is what i think if the turning, the growing pains of going from an opposition party to going to a governing party that delivers. , more thannt is
anybody else today, helping bridge these gaps and bring people together. let me ask you want something to focus on a negative as a journalist should. simmer think there is unlikely going to be a consensus. you have been clear for years and we have seen compelling powerpoint presentations about how beef entitlements -- how these entitlements are driving the country into a ditch on the debt. we have a president who seems touch in times. where does that leave us? rep. ryan: the entitlements are the big drivers our -- of our debt. there is balm there, medicaid, and medicare. two out of three are going to congress right now. medicaid, sending it back to the states, capping its growth rates. we have been dreaming of this since i have been around, since you and i were drinking at a keg. [laughter]
i was thinking about reforming medicaid. [laughter] rep. ryan: we are on the cost of doing something -- cost of doing something we have long of -- long believed in. repealing obamacare. medicare, this is not in this bill because it is not a medicare bill. that issue we are going to have to keep talking about and discussing. i think two out of three of the thosefour months out of any day. --you want to prevent prevent a debt crisis, you have to deal with and battlement issues. we long championed on the 65 and above his prospective. don't change benefits for people in or ar retirement, but do it for us in the next generation on
down prospectively admitted market-based. we really believe that works. that is a discussion we are going to keep having. the president has been clear about this. his focus is making sure that people who count on these programs, about two retire, who organize their lives around these promises, have those promises kept. we agree with that. mr. lowry: thank you so much for doing it. god speed. [applause] rep. ryan: appreciated. mr. lowry: joining us is dr. tom price. director of health and human services. [applause] he came to that job just a little more than a month ago. having been thrown into the firestorm you are thrown into. he has been at the center of the health care